Innovations for the future of breast surgery.
No Thumbnail Available
Authors
Vidya, Raghavan
Issue Date
2021-05-31
Journal
Type
Article
Peer-Reviewed Publication
Peer-Reviewed Publication
Keywords
Adjuvant therapy
Axilla
Biological markers
Breast
Breast cancer
Breast surgery
Chemotherapy
Breast conserving surgery
Cost-effectiveness
Diagnostic imaging
Excision
Expert opinion
Forcasting
Gene expression profiling
Intraoperative care
Morbidity
Narrative review
Neoadjuvant therapy
Neoplasms
Oncoplastics
Operative
Outcomes
Patient centred care
Prevention
Reconstructive surgical procedures
Reexcision
Residual tumour
Review
Segmental mastectomy
Sentinel lymph node biopsy
Surgical procedures
Surgery specialty
Systemic therapy
Technology
Axilla
Biological markers
Breast
Breast cancer
Breast surgery
Chemotherapy
Breast conserving surgery
Cost-effectiveness
Diagnostic imaging
Excision
Expert opinion
Forcasting
Gene expression profiling
Intraoperative care
Morbidity
Narrative review
Neoadjuvant therapy
Neoplasms
Oncoplastics
Operative
Outcomes
Patient centred care
Prevention
Reconstructive surgical procedures
Reexcision
Residual tumour
Review
Segmental mastectomy
Sentinel lymph node biopsy
Surgical procedures
Surgery specialty
Systemic therapy
Technology
Journal Title
British Journal of Surgery
Volume
Issue
Begin page
End page
Abstract
Background: Future innovations in science and technology with an impact on multimodal breast cancer management from a surgical perspective are discussed in this narrative review. The work was undertaken in response to the Commission on the Future of Surgery project initiated by the Royal College of Surgeons of England.
Methods: Expert opinion was sought around themes of surgical de-escalation, reduction in treatment morbidities, and improving the accuracy of breast-conserving surgery in terms of margin status. There was emphasis on how the primacy of surgical excision in an era of oncoplastic and reconstructive surgery is increasingly being challenged, with more effective systemic therapies that target residual disease burden, and permit response-adapted approaches to both breast and axillary surgery.
Results: Technologies for intraoperative margin assessment can potentially half re-excision rates after breast-conserving surgery, and sentinel lymph node biopsy will become a therapeutic procedure for many patients with node-positive disease treated either with surgery or chemotherapy as the primary modality. Genomic profiling of tumours can aid in the selection of patients for neoadjuvant and adjuvant therapies as well as prevention strategies. Molecular subtypes are predictive of response to induction therapies and reductive approaches to surgery in the breast or axilla.
Conclusion: Treatments are increasingly being tailored and based on improved understanding of tumour biology and relevant biomarkers to determine absolute benefit and permit delivery of cost-effective healthcare. Patient involvement is crucial for breast cancer studies to ensure relevance and outcome measures that are objective, meaningful, and patient-centred.
Citation
Vidya R, Leff DR, Green M, McIntosh SA, St John E, Kirwan CC, Romics L, Cutress RI, Potter S, Carmichael A, Subramanian A, O'Connell R, Fairbrother P, Fenlon D, Benson J, Holcombe C. Innovations for the future of breast surgery. Br J Surg. 2021 May 31:znab147. doi: 10.1093/bjs/znab147. Epub ahead of print. PMID: 34059874.